Feasibility of pathways for the organizational and quality aspects of the use of positron emission tomography in patients with suspected post-transplant lymphoma

As nuclear physicians, we wanted to assess the opportunities and chances of success of clinical pathways in our daily clinical practice, and therefore, we initiated an integrated project concerning the use of positron emission tomography (PET) for the diagnosis of post-transplant lymphoma (post-transplant lymphoproliferative disorder [PTLD]). PTLD is a pathology that occurs typically after long-term immunosuppression in a transplant patient, and often behaves as an aggressive lymphoma. We evaluated the possible benefits of a clinical pathway through the evaluation of the accuracy and cost-effectiveness of PET in this setting. We looked at the difficulties during the development of such a clinical pathway and tried to predict its chances of success. We showed a high accuracy and a substantial financial benefit for the use of PET. Despite this clear benefit, the development of a clinical pathway including PET for diagnosis in PTLD is very difficult due to the very heterogeneous patient population, the urgent nature of the disease and the structure of the organization of the nuclear department. Consequently, the chances of success of such a pathway seem limited to us at this time point, and we propose a different management of the patients with suspicion of PTLD, namely through the development of a central disclosure point.